Rethinking ACL return to sport timelines

ACL reconstruction and return to sport (RTS) timelines. Should we consider extending the return to sport timelines from 6-9 months to 24 months? The (RTS) model is specifically related to the athletes who are involved in high-level landing and pivoting sports. The latest research and debate for younger athletes to (RTS) is related to the increased retear rate of up to 30% in the first two years of (RTS). The model surrounds two main themes 1) Biological Responses and 2) Functional Recovery. Biological responses include graft maturation (ligamentization), sensory restoration, and absence of bone bruises. Functional recovery includes Biomechanical and neuromuscular control and the return of quad strength. If we return the repaired knee to more baseline the retear rate drops. However,

the question remains can we get buy-in from coaches, parents, and is the in the best interest of the athlete. We have many success stories of athletes who (RTS) in the 6-9 month window but what about the athlete who doesn't. Can we do better?